Portugal's Healthcare Crisis: Glaucoma Drug Shortage, Hospital Strikes, and Addiction Surge Impact Thousands

Health,  National News
Pharmacy shelves with prescription medications and healthcare documentation in professional setting
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Medicine Stock-Outs, Labor Unrest, and Cocaine Surge: Portugal's Health System Under Pressure

The Portugal National Authority for Medicines (Infarmed) has confirmed that two widely prescribed glaucoma medications will be unavailable until summer due to manufacturing constraints, forcing thousands of patients onto substitute formulas that many cannot tolerate. Meanwhile, healthcare workers across multiple facilities are escalating strike threats over stalled contract negotiations, and the Portugal Institute on Drugs and Drug Addiction (ICAD) warns that crack cocaine use has exploded by 60% among prison populations, marking a dangerous new chapter in the country's drug crisis.

Why This Matters

Glaucoma patients face forced medication switches that could trigger allergic reactions or treatment gaps lasting up to five months.

Healthcare staff strikes planned for March 19 at major Lisbon hospitals threaten to disrupt services for over 1.3 million residents.

Crack cocaine now dominates Portugal's fastest-growing addiction category, with emergency overdoses linked to the stimulant at decade highs.

Disability assessment backlogs have prompted presidential intervention, with tens of thousands awaiting medical evaluations for essential benefits.

Glaucoma Drug Crisis Forces Risky Substitutions

Infarmed issued an emergency circular this week alerting pharmacies and ophthalmologists that Monoprost Duo and Encil Duofree—the only preservative-free combination formulas for glaucoma and ocular hypertension—will be out of stock through April and July, respectively. The shortage stems from "manufacturing bottlenecks" at the production facilities, though the regulator provided no specifics on supplier identity or root cause.

Both medications combine latanoprost and timolol, a dual-action therapy that lowers intraocular pressure by reducing fluid production and improving drainage. The preservative-free versions are critical for patients with benzalkonium chloride hypersensitivity, a common reaction that causes burning, redness, and corneal damage in an estimated 15–20% of chronic glaucoma cases.

To prevent treatment interruptions—and spare patients costly repeat consultations—Infarmed has authorized pharmacists to substitute standard preservative-containing alternatives on existing valid prescriptions. However, the circular emphasized that patients allergic to benzalkonium chloride or other preservatives must not receive substitutes and should be directed back to their prescribing physician for alternative therapy, likely switching to monotherapy or non-topical treatments.

The agency urged pharmacies to reserve remaining preservative-free stock for the most vulnerable cohorts, particularly those with documented allergies or severe ocular surface disease. Glaucoma is the second-leading cause of blindness in Portugal, affecting an estimated 120,000 residents, most over age 60.

Healthcare Workers Escalate Strike Threats Across Multiple Fronts

Lisbon's Largest Hospital Faces 16-Hour Walkout

Auxiliary health technicians at Portugal's Santa Maria Local Health Unit (ULS Santa Maria), one of the capital's largest hospital networks, voted this morning to stage a 16-hour strike on March 19, affecting day and evening shifts from 8 a.m. to midnight. The action, organized by the Southern and Autonomous Regions Public and Social Workers' Union, centers on management's refusal to apply performance evaluations for the 2023–2024 period or set objectives for 2026.

Ana Amaral, a union representative, told reporters that ULS Santa Maria claims the newly created auxiliary technician career track exempts staff from the standard civil service evaluation system (SIADAP). Yet Portugal's Lisbon Occidental ULS, Amadora/Sintra ULS, and the Lisbon Portuguese Oncology Institute have all processed evaluations for identical roles under general public administration law.

"This isn't a legal gray area—it's institutional obstinacy," Amaral stated. "These are 1,350 frontline workers earning near-minimum wage, and they're being told their performance doesn't even warrant documentation."

ULS Santa Maria countered that the evaluation framework "is finalized and awaiting homologation by the Central Health System Administration (ACSS)," citing the need for approval of new salary grids tied to the restructured career.

Diagnostic Technicians Warn of Nationwide Action

Separately, the Union of Superior Diagnostic and Therapeutic Technicians (Sindite) issued an ultimatum to the Portugal Ministry of Health after two consecutive negotiation sessions—scheduled for January 28 and February 18—were postponed. The union, representing professionals in radiology, nuclear medicine, physiotherapy, audiology, clinical analysis, and 15 other specialties, accused the government of "institutional disrespect" and warned it will pursue "all legally available industrial actions" if the rescheduled February 24 meeting fails to yield concrete proposals.

Many of these technicians hold master's degrees or doctorates yet face salary compression and outdated career progression scales dating to the early 2010s. Sindite emphasized that these roles are "indispensable to National Health Service operations," with shortages already forcing appointment delays in imaging, cardiac diagnostics, and speech therapy across rural districts.

What This Means for Residents

If you take glaucoma medication: Contact your pharmacy immediately to confirm stock availability. If you've experienced eye irritation from standard drops in the past, schedule an ophthalmology appointment now—wait times for specialist consultations in Lisbon and Porto average three to four months. Do not stop medication without medical guidance; untreated glaucoma can cause irreversible vision loss within weeks.

If you use Santa Maria or other major Lisbon hospitals: Expect reduced non-urgent services on March 19. Surgical procedures, diagnostic imaging, and outpatient clinics may face cancellations or delays. Emergency departments will remain staffed at minimum legal levels, but wait times could double. Check your hospital's website or call ahead if you have scheduled appointments that week.

For disability benefit applicants: The backlog remains severe despite presidential approval of overtime measures. If your Multiuse Disability Certificate evaluation has been pending more than six months, contact your Local Health Unit or the regional health administration to request status updates under the new extraordinary recovery process.

Regional Health Disputes and Storm Recovery

Penamacor Clinic Standoff Ends in Compromise

In the Castelo Branco district, tensions eased this week between municipal authorities and the Castelo Branco Local Health Unit over the partial closure of the Complementary Care Service (SAC) in Penamacor. The facility had been ordered to shut on days without a rostered physician, prompting protests from Mayor José Miguel Oliveira, who called the unilateral decision "profoundly wrong and disrespectful to local government."

A joint statement issued Saturday confirmed the SAC will reopen when doctors are available and that primary care services in the same building remain fully operational. The municipality pledged continued collaboration on staffing solutions, while the ULS emphasized "no loss of services" for the town's residents.

Coimbra Deactivates Emergency Protocols After Storms

The Coimbra Local Health Unit stood down its Level 2 Emergency External Plan and Internal Emergency Plan after the region exited calamity status Sunday. The protocols, activated during the passage of Storms Kristin, Leonardo, and Marta, had mobilized additional staff and expanded surge capacity across emergency departments and intensive care units.

The three storms killed 16 people nationwide and caused widespread infrastructure damage, with Centro, Lisbon, and Alentejo regions bearing the brunt. The ULS thanked healthcare workers who "maintained service operability despite personal losses" from flooding and structural collapses.

Critical Care Director Resigns Over "Institutional Disrespect" in Viana do Castelo

Dr. Pedro Moura, director of critical care medicine at the Alto Minho Local Health Unit, resigned effective Monday after 28 years at the Santa Luzia Hospital in Viana do Castelo, citing "systematic institutional disrespect" by senior management. In a letter to staff, Moura accused the clinical directorate and executive board of sidelining his department, dismantling the critical patient circuit, and appointing a new intensive care service chief without consultation.

Key grievances included:

Removal of the emergency department from critical care oversight last summer, jeopardizing training accreditation for the intensive care service.

Unacknowledged proposals for an integrated critical care responsibility center, artificial intelligence integration, and service restructuring.

Appointment of a rival director for intensive medicine in February 2026 "with a different project," communicated only via internal circular with no prior discussion.

Moura, who described his tenure as defined by "commitment at great personal and family cost," said he remains willing to collaborate if management changes its approach. The ULS Alto Minho accepted the resignation and stated that "departmental operations are secured and patient care continuity guaranteed," but provided no further comment on the allegations.

Crack Epidemic Hits Prisons as Cocaine Overdoses Surge

The Portugal Institute on Drugs and Drug Addiction (ICAD) reported to parliament this week that crack cocaine offenses among indicted and convicted prisoners rose 60% in 2024, reflecting both the drug's growing street prevalence and its association with violent crime. President Joana Teixeira, a psychiatrist, emphasized that the substance's five-minute onset and rapid crash creates compulsive re-dosing patterns far more severe than powder cocaine, which peaks after 20 minutes.

"Crack has a much higher addictive potential and much graver health and social repercussions," Teixeira told the Health Parliamentary Committee. She noted that most incarcerated users were already dependent before arrest, and the drug's rapid cycle drives the "back-and-forth to dealers" that fuels street violence.

Key findings from the 2024 ICAD Annual Report:

Treatment admissions for substance use reached the highest level in a decade, driven overwhelmingly by stimulants.

Cocaine purity hit a 10-year high, while heroin purity fell to its lowest point in the same span.

Four clandestine labs converting coca paste to cocaine hydrochloride were dismantled in 2024, signaling potential domestic production expansion mirroring trends in Spain and the Netherlands.

Hashish potency also peaked, while seizures of crack declined slightly from 2023's record, though still far above pre-2022 levels.

Teixeira warned of polydrug combinations—crack laced with synthetic opioids, vitamins, or novel psychoactive substances—that amplify addiction and overdose risk. ICAD is developing new prevention and harm-reduction protocols in partnership with municipalities, social services, and psychiatric facilities.

Presidential Green Light for Disability Evaluation Reforms

President Marcelo Rebelo de Sousa formally promulgated legislation last Thursday establishing an extraordinary process to clear disability assessment backlogs, a chronic problem affecting tens of thousands of applicants for the Multiuse Disability Certificate. The measure, approved by parliament in January over objections from the Social Democratic Party (PSD), mandates overtime pay for medical evaluators and requires a full 60-day inventory of pending requests.

Wait times in Lisbon and Porto metropolitan areas have stretched beyond 18 months in some cases, delaying access to tax benefits, parking permits, transportation subsidies, and employment protections. The Socialist Party (PS), which sponsored the bill, argued that preparatory work under the prior government identified overtime expansion as the only viable short-term fix.

Implementation now depends on regulatory details from the Ministry of Health, which must approve overtime frameworks and allocate budget. The president's statement acknowledged "good intentions" but noted the law's effectiveness hinges on "the regulations the government chooses to approve."

Looking Ahead

The confluence of drug supply shocks, labor disputes, and system capacity strains underscores the structural fragility of Portugal's National Health Service as it navigates post-pandemic recovery and demographic aging. With glaucoma medication shortages exposing supply-chain vulnerabilities, strike action threatening urban care continuity, and crack cocaine reshaping the addiction landscape, policymakers face mounting pressure to deliver not just emergency fixes but sustainable reforms to workforce conditions, procurement resilience, and public health infrastructure.

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